This blog is totally independent, unpaid and has only three major objectives.
The first is to inform readers of news and happenings in the e-Health domain, both here in Australia and world-wide.
The second is to provide commentary on e-Health in Australia and to foster improvement where I can.
The third is to encourage discussion of the matters raised in the blog so hopefully readers can get a balanced view of what is really happening and what successes are being achieved.

Wednesday, June 15, 2016

I Have Heard Of Some Health IT Fiascos But This One Is Right Up There!

Nine weeks after rolling out the paperless iHealth system, Nanaimo hospital’s intensive-care and emergency departments have reverted to pen and paper “out of concern for patient safety.”

Photograph by: Sherry Yates Young , Vancouver Sun

Implementation of a $174-million Vancouver Island-wide electronic health record system in Nanaimo Regional General Hospital — set to expand to Victoria by late 2017 — is a huge failure, say senior physicians.

After a year of testing, the new paperless iHealth system rolled out in Nanaimo on March 19. Island Health heralds the system as the first in the province to connect all acute-care and diagnostic services through one electronic patient medical record, the first fully integrated electronic chart in the province.

But nine weeks after startup, physicians in the Nanaimo hospital’s intensive-care and emergency departments reverted to pen and paper this week “out of concern for patient safety.”

Doctors said the system is flawed — generating wrong dosages for the most dangerous of drugs, diminishing time for patient consultation, and losing critical information and orders.

“The whole thing is a mess,” said a senior physician. “What you type into the computer is not what comes out the other end.

“It’s unusable and it’s unsafe. I’m surprised they haven’t pulled it. I’ve never seen errors of the kind we are now seeing.”

Doctors are so concerned, they want Island Health to suspend the implementation.

“Take it away and fix it and test it before you bring it back — stop testing it on our people,” said one doctor. “Why wasn’t this introduced in Victoria first? If they went live in Victoria first, they would have a riot.”

The doctors, who fear reprisals, spoke to the Times Colonist on condition of anonymity.

The $174-million system started with a 10-year, $50-million deal for software and professional services signed in 2013 with Cerner Corporation, a health information technology company headquartered in Kansas City. Thus far, the company has been paid close to $12 million. The remaining $124 million is to be spent by Island Health for hardware, training and operating the system.

The system is being used in Nanaimo’s hospital, Dufferin Place residential care centre (also in Nanaimo), and Oceanside Health Centre in Parksville.

Since March 19, mobile touch-screen computer console carts have been rolling around hospital hallways. Voice-recognition dictation software immediately transcribes a doctor’s verbal notes into a patient’s electronic record, and scanners track each bar-coded patient bracelet around the hospital.

But doctors complain the new technology is slow, overly complicated and inefficient.

“The iHealth computer interface for ordering medications and tests is so poorly designed that not only does it take doctors more than twice as long to enter orders, even with that extra effort, serious errors are occurring on multiple patients every single day,” wrote one physician at the Nanaimo hospital.

“Tests are being delayed. Medications are being missed or accidentally discontinued.”

4 comments:

There are also complaints about the pharmacy module of Cerner’s integrated system — the only joint build between Island Health and Cerner.

In light of the following I find it rather odd given that Cerner promotes its pharmacy system in Australia to NSW, QLD and VIC hospital clients.

“The iHealth computer interface for ordering medications and tests is so poorly designed that not only does it take doctors more than twice as long to enter orders, even with that extra effort, serious errors are occurring on multiple patients every single day,” wrote one physician at the Nanaimo hospital.“Tests are being delayed. Medications are being missed or accidentally discontinued.”

I always though the reason hospitals were dangerous places to be in was because of the risk of cross infection and super bugs. ...... medications are being missed - adds a whole new dimension to hospital dangers. Best to have day only procedures wherever possible including such procedures as a repair of an inguinal hernia.

Twice as long as what? as it takes to scribble something unintelligible on a piece of paper? Twice as long as it takes to order OTC medications through Medical Director with no overlaid processes? Twice as long as tasking a nurse to sort it out?

As for “Tests are being delayed. Medications are being missed or accidentally discontinued.” - any review of any hospital system shows that this is already the case.

A useful journalist would ask interesting questions like, "more, or less?" But we don't have many of them. in the absence of that, we have no way to judge whether this represents real problems, or petulance, or just a transient position in salary negotiations.

Hear Rene Lemai's words of wisdom from this morning:

"There is also no doubt that hospitals, above all other institutions, are less likely to agree to change their business processes than to demand that software changes to meet their business processes. As we’ve seen in many, many IT project implementations over the years, this is generally a terrible approach that often results in project failure"

Message to the ADHA board and new executive (ehealth branch and Nehta) are less likely to agree to change their business processes - or thought patterns, simply because they have an entrenched pattern of thinking.

The complaints seem, from the article, to be poorly articulated. But this could be journalistic distortion.

However, in regards to testing, the assessment is probably right. I have never seen a system installed into a clinical environment that has had the level of testing I would consider reasonable. Testing is just added on to a project plan as an afterthought. I have only seen testing effect a go-live date when it showed critical defects that stopped the application actually working. Subtle stuff is fixed "sometime after go-live".